Behaviour Support Plans (BSP) for Residential Aged Care

Residential aged care providers must have behaviour support plans (BSPs) in place for all residents who require or might require the use of restrictive practices (ACQSC 2021).

This requirement is an update to the Quality of Care Principles 2014, in accordance with the Aged Care and Other Legislative Amendment (Royal Commission Response No.1) Act 2021 (Cth) (Manganaro 2021).

What is Behaviour Support?

Sometimes, aged care residents display behaviours that indicate they require extra support. These are known as changed behaviours. Often, changed behaviours signal that the resident is experiencing stress, wants to communicate something or has an unmet need (DSA 2021).

Some reasons why changed behaviours might occur include:

Pain, discomfort or illness
Interruption to routine
Fatigue
Medication changes, side effects or interactions
Changes to the living environment
Life events
Wanting to communicate something
Boredom or loneliness
Delirium
Constipation
Dehydration
Hunger or low blood sugar
Mental illness (e.g. depression or anxiety)
Hallucinations or delusions
Sensory impairment.

(Carer Gateway 2015; Burkett 2023)

Behaviour support involves developing processes and strategies to proactively respond to and care for residents who are displaying changed behaviours, and avoiding anything that might negatively affect these behaviours (DSA 2021).

What is a Behaviour Support Plan (BSP)?

worker and client discussing behaviour support plan

A behaviour support plan (BSP) assists in the care and support of a resident who displays changed behaviours (ACQSC 2022).

It forms part of a resident’s existing care and services plan and is required for any resident who:

Displays changed behaviours
Has been assessed as requiring the use of a restrictive practice, or
Is currently experiencing a restrictive practice.

(DoHaAC 2024)

The Behaviour Support Process

Dementia Support Australia lists five steps of the behaviour support process:

Identify
Assess
Plan
Implement
Evaluate

1. Identify

The first step is to recognise behaviours that indicate a resident might require additional support.

Examples of changed behaviours include:

Verbal disruptions
Sleep disturbances
Inappropriate sexual behaviours
Physical aggression
Refusal to accept help or services
Wandering or intrusiveness
Inappropriate social behaviours
Issues related to eating
Resistance to personal care
Repetitive actions or questions.

(DSA 2021, 2022)

Upon noticing these behaviours, your immediate priority should be to take appropriate action to ensure the safety of the resident and others. If the resident has an existing care plan in place, this should be implemented (DSA 2021).

Once the situation has been resolved, the changed behaviour should be appropriately reported (DSA 2021).

2. Assess

This step involves using the ABC Approach to Behaviour Management to better understand why the resident is behaving this way and identify any underlying causes (DSA 2022).

For more information on the ABC approach, see the Article: Behaviour Management and BPSD.

During this step, you might need to consider different aspects of the resident’s life, including:

Physical health
Cognitive health
Personality
Whether they are experiencing sensory issues
Life history and what matters to them
Mental health
Environmental factors
Relationships
Communication skills and abilities
Routine
Engagement or lack of engagement.

(DSA 2021, 2022)

3. Plan

The next step is to develop a BSP in consultation with the resident. This should be individualised and tailored to the resident’s preferences and needs (DSA 2021).

A BSP may include interventions such as engagement strategies, communication strategies or environmental strategies (DSA 2021).

What Should a Behaviour Support Plan Contain?

Note: For a more comprehensive explanation of what needs to be included in a BSP, see the Quality of Care Principles 2014.

According to the Quality of Care Principles, a BSP must set out the following:

Alternative strategies for addressing changed behaviours:	Information about the resident’s background and past experiences that may help the provider to better understand the resident’s behaviour Assessments of the resident that may help the provider to better understand the resident’s behaviour Changed behaviours that the resident may require support for Information about each occurrence of changed behaviour where the resident required support, including: The date, time and duration of the changed behaviour Any negative consequences experienced by the resident or other people Any related incidents Any warning signs, triggers or causes of the changed behaviour (e.g. trauma, injury, illness or unmet needs) Alternative strategies for addressing these changed behaviours that: Are best-practice Take the resident’s preferences and matters of interest into consideration Aim to optimise the resident’s quality of life and engagement Alternative strategies that have been considered for use, or have been used For any alternative strategies that have been used: How effective these strategies were in addressing the changed behaviour Records of the monitoring and evaluation of the strategies A description of the provider’s consultation about the use of alternative strategies, either with the resident or the resident’s representative
If the use of a restrictive practice has been assessed as necessary:	The resident’s changed behaviours requiring the use of a restrictive practice The restrictive practice to be used, including its intended duration, frequency and outcome, and how to use it Best-practice alternative strategies that must be considered before using the restrictive practice The way in which the use of the restrictive practice will be monitored and reviewed A description of the provider’s consultation about the use of the restrictive practice, either with the resident or a substitute decision‑maker (if the resident cannot give consent) A record of informed consent from the resident or a substitute decision‑maker.
If a restrictive practice has been used:	The restrictive practice and how it was used, including: When it began to be used The duration of each use How often it is used The outcome of the use, and whether the intended outcome was achieved If the restrictive practice is being used on an as‑needed basis: The changed behaviour that led to the restrictive practice being used Any actions that were taken prior to using the restrictive practice (e.g. alternative strategies) The details of the people involved in the use of the restrictive practice The details of engagement with external support services in relation to the use of the restrictive practice Details of the monitoring and review of the use of the restrictive practice as required by the BSP
If the ongoing use of a restrictive practice is required:	The restrictive practice to be used, including its intended duration, frequency and outcome, and how to use it How the ongoing use of the restrictive practice will be monitored and reviewed A description of the provider’s consultation about the use of the restrictive practice, either with the resident or a substitute decision‑maker (if the resident cannot give consent) A record of informed consent from the resident or a substitute decision‑maker

4. Implement

Once the BSP has been developed, these strategies should be implemented. Each person involved in the resident’s care must understand their new responsibilities and be able to confidently deliver the resident’s support strategies (DSA 2021).

Being able to consistently implement support strategies is crucial (DSA 2021).

5. Evaluate

The BSP is expected to be regularly reviewed and revised to assess the effectiveness of support strategies and ensure the resident is being supported in a way that best meets their care needs (DSA 2021).